This study aimed to analyze the development and implementation of an adapted physical activity day expected to underline to overweight/obese youth the role of PA and hw they could be more active in their ... [more ▼]

This study aimed to analyze the development and implementation of an adapted physical activity day expected to underline to overweight/obese youth the role of PA and hw they could be more active in their daily life. [less ▲]

Abstract The aim of this article is to review some common opinions on changes in pubertal timing and shed new light both on the indicators used in assessing pubertal timing and the underlying mechanisms ... [more ▼]

Abstract The aim of this article is to review some common opinions on changes in pubertal timing and shed new light both on the indicators used in assessing pubertal timing and the underlying mechanisms. While emphasis is usually on advancement in timing of female puberty, it appears that timing also changes in males, both towards earliness for the initial pubertal stages and towards lateness for the final stages. Such findings suggest that the environmental influences on pubertal timing are more complex than initially thought. Moreover, self-evaluated pubertal timing versus peers provides information that is not always consistent with observations at physical examination, suggesting that both perspectives should be considered, especially when studying the correlation between pubertal timing and psychosocial aspects. The mechanisms of changes in pubertal timing may involve both central neuroendocrine control and peripheral effects in tissues targeted by gonadal steroids. Though energy availability is certainly a clue to the mechanism of pubertal development, changes in the control of both energy balance and control of reproduction may vary under the influence of common determinants such as endocrine-disrupting chemicals. These effects can take place right before puberty as well as much earlier, during fetal and neonatal life. Finally, environmental factors can interact with genetic factors in determining changes in pubertal timing. Therefore, the variance in pubertal timing is no longer to be considered under the absolutely separate control of environmental and genetic determinants. [less ▲]

Irwin et al. (2003) pointed out the principles that quality PE teachers should incorporate into their pedagogical practice in order to take into account the increasing number of overweight and obese ... [more ▼]

Irwin et al. (2003) pointed out the principles that quality PE teachers should incorporate into their pedagogical practice in order to take into account the increasing number of overweight and obese students in their classes. Fighting against obesity is so complex that no simple solution can be proposed. It means that the development of specific tools providing PE teachers with new instructional strategies inspired from public health is needed (Prusak et al., 2011). Inclusion of overweight students into PE can be linked with a social ecological model (Li & Rukavina, 2012). Even if PE teachers are able to develop and implement specific instructional strategies, it seems that they need support from health experts (Cloes et al., 2013). Internet, continuing professional development activities, and educational info capsules were identified as the preferred supports to be used by the practitioners (Cloes et al., 2014). The aims of this study were to produce and validate three pedagogical capsules focusing on specific concerns of PE teachers as well as to analyze the procedure of validation. Using an extensive analysis of the literature, the researchers first identified theoretical and practical resources to be mobilized in the understanding and development of solutions for the selected problems: (1) Students’ lack of awareness about the risks of overweight and obesity; (2) Constraints associated with the motor/physical disabling; (3) Parents’ lack of awareness about PA impact on health. The capsules were then submitted to 11 experts (health specialists, health educators, psychologists, PE teachers) who had to analyze the documents. They acknowledged the content and form of the capsules. Minor changes were requested in order to finalize them. The proposed evaluation sheet was also validated but face-to-face assessment was recommended. Dissemination of the existing capsules as well as development of additional ones should be the next steps of this project. [less ▲]

Despite ‘antifat’ attitude of some PE teachers (Greenleaf & Weiller, 2005) and the PE public relations problem in regard to how obese students are treated (Irwin et al., 2003), it seems evident that this ... [more ▼]

Despite ‘antifat’ attitude of some PE teachers (Greenleaf & Weiller, 2005) and the PE public relations problem in regard to how obese students are treated (Irwin et al., 2003), it seems evident that this school subject represents a key element in the involvement of the education sector in the fight against the worldwide escalating global epidemic of obesity (Tappe & Burgeson, 2004). In fact, PE teachers consider that they lack of specific knowledge to implement instructional strategies dealing with overweight and obese students (Cloes & Ziant, 2009). Some authors proposed models to illustrate constraints that PE teachers encounter in their classes with obese students and their potential solutions (Cloes et al., 2013; Rukavina et al., 2010). On the other hand, data are missing when identifying those that are considered as their main concerns and the ways that they would prefer to receive some support regarding this specific topic. This study is focused on these two aspects. Five hundred thirteen PE teachers fulfilled an online questionnaire (Lickert scales) in which they had to determine (1) the perceived importance of 20 problems proposed by PE teachers and validated by 8 experts; (2) their relative interest toward the reception of support aiming to deal with those problems; (3) their preference for receiving information about the potential instructional strategies. Based on the answers, the top 3 problems are: (1) Students’ lack of awareness about the risks of overweight and obesity; (2) Constraints associated with the motor/physical disabling; (3) Parents’ lack of awareness about physical activity impact on health. Internet (3.49±.6/4), continuing professional development activities (3.29±.8/4), and educational info capsules (3.07±.8/4) were identified as the main resources that PE teachers would use preferentially. This study provides useful information for PE teachers’ educators who should develop now material to be shared with the practitioners. [less ▲]

Neonatal hyperthyroidism is a rare pathology, most often the consequence of Graves' disease in the mother. Around 0.2% of pregnant women have Graves disease and 1 to 2% of newborns of mother with Graves ... [more ▼]

Neonatal hyperthyroidism is a rare pathology, most often the consequence of Graves' disease in the mother. Around 0.2% of pregnant women have Graves disease and 1 to 2% of newborns of mother with Graves' disease. This article will describe the case of 4 newborns who have been diagnosed and treated in CHU-NDB between 2007 and 2011. The second part will focus on the new recommendations about the management of these young patients from foetal period to birth. [less ▲]

Purpose. Overweight and obesity take a growing place in the public health preoccupations as the proportion of people over the normal BMI limit increases dramatically year after year. This evolution could ... [more ▼]

Purpose. Overweight and obesity take a growing place in the public health preoccupations as the proportion of people over the normal BMI limit increases dramatically year after year. This evolution could have devastating consequences on the economy for years and possibly generations to come. Youth physical activity is pointed out as a priority. Fitness centres are possible partners of health services. This study aimed to know if overweight/obese youth could be welcomed into a sample of fitness centres. Methods. A sample of 13 fitness centres of the Liege area was visited. Fourteen interviews with the managers have been conducted. Specific questions were asked about what is proposed to overweight and obese people and specifically to youth group. Content analysis has been done from verbatim transcripts. Results. Most of the subjects consider that overweight/obese youth could encounter some difficulties to adhere to a fitness centre. Unfounded embarrassment about the look of others is underlined by 7 out of the managers. The real intrinsic motivation of the youth would be a key factor as well as real difficulties to use the equipment. Few fitness centres currently propose specific activities but 7 would be ready to collaborate with a medical unit in order to propose specific activities. Two decided to stop such initiatives according to the cost and lack of perseverance of the youth. Conclusions. This study showed that fitness centres managers would be interested to implement initiatives to offer specific services to overweight/obese youth but it would require collaboration with health services. [less ▲]

We aimed to investigate care processes and outcomes among children and adolescents with type 1 diabetes treated in hospital-based multidisciplinary paediatric diabetes centres. Our retrospective cross-sectional study among 12 Belgian centres included data from 974 patients with type 1 diabetes, aged 0-18 years. Questionnaires were used to collect data on demographic and clinical characteristics, as well as process of care completion and outcomes of care in 2008. Most patients lived with both biological or adoption parents (77 %) and had at least one parent of Belgian origin (78 %). Nearly all patients (>/=95 %) underwent determination of HbA(1c) and BMI. Screening for retinopathy (55 %) and microalbuminuria (73 %) was less frequent, but rates increased with age and diabetes duration. Median HbA(1c) was 61 mmol/mol (7.7 %) [interquartile range 54-68 mmol/mol (7.1-8.4 %)] and increased with age and insulin dose. HbA(1c) was higher among patients on insulin pump therapy. Median HbA(1c) significantly differed between centres [from 56 mmol/mol (7.3 %) to 66 mmol/mol (8.2 %)]. Incidence of severe hypoglycaemia was 30 per 100 patient-years. Admissions for ketoacidosis had a rate of 3.2 per 100 patient-years. Patients not living with both biological or adoption parents had higher HbA(1c) and more admissions for ketoacidosis. Parents' country of origin was not associated with processes and outcomes of care. Conclusion: Outcomes of care ranked well compared to other European countries, while complication screening rates were intermediate. The observed centre variation in HbA(1c) remained unexplained. Outcomes were associated with family structure, highlighting the continuing need for strategies to cope with this emerging challenge. [less ▲]

BACKGROUND. Overweight and obesity in youth must be combated through a multiple approach combining management principles in nutrition and physical activity (PA). In the hospital context, medical staff ... [more ▼]

BACKGROUND. Overweight and obesity in youth must be combated through a multiple approach combining management principles in nutrition and physical activity (PA). In the hospital context, medical staff seems to be more focused on nutrition. AIM. In this study, we proposed to implement a specific intervention focusing on PA in parallel with traditional paediatric and dietetic visits designed to 6-12 year-old children. METHODS. Data were collected in three steps: (1) after a visit at the hospital, subjects and their parents answered to a questionnaire (lifestyle, representation about PA) and attended to a meeting during which they received written (illustrated booklet) and oral cues about PA as well as an invitation to use a PA diary and a pedometer; (2) before the next visit (almost 8 weeks interval), they were free to apply the recommendations; (3) after the next visit to the hospital, subjects analyzed the diary with one of the researchers and answered to questions about their current lifestyle and representations about PA. 34 children respected the whole protocol. FINDINGS. Among the children and their parents, representations of PA changed between the visits (PA was no longer regarded merely as sport). Major changes were also identified in children’s lifestyle (increase of number of weekly PA, family PA, weekly PA time; decrease of inactivity time like TV or video games). Only 27 children out of 34 used the PA diary at least once (information were recorded for a mean of 18 days/child between the 2 visits – a third of the duration of the interval). The pedometer has been used by 15 children and was considered as a motivating tool. 58.5% of comments collected at the end of the second meeting were positive and emphasized the interest of the intervention; 24.6% were negative and mainly focused the PA diary). DISCUSSION. This study underlines the need to improve the family's representations about PA in paediatric and dietetic visits. It supports PA experts' integration in the staff. [less ▲]

AIM: To study the relationship between insulin sensitivity and growth response in short children born small for gestational age (SGA) treated with growth hormone (GH). METHODS: Randomized, open-label, 24 ... [more ▼]

AIM: To study the relationship between insulin sensitivity and growth response in short children born small for gestational age (SGA) treated with growth hormone (GH). METHODS: Randomized, open-label, 24-month intervention study in 40 short prepubertal SGA children [age (mean +/- SD) 5.3 +/- 1.5 years], who either remained untreated (n = 20) or were treated with GH (66 microg/kg/day; n = 20). Changes in fasting glucose, insulin, quantitative insulin sensitivity check index (QUICKI), IGF-1 and leptin after 1 and 2 years were studied. RESULTS: Mean height SDS increased from -3.3 +/- 0.7 to -2.3 +/- 0.7 after 1 year, and to -1.9 +/- 0.7 after 2 years of treatment. QUICKI decreased significantly (p = 0.008) in the first year of GH treatment and stabilized in the second year. Baseline QUICKI was positively associated (r = 0.40; p < 0.05) with the change in height SDS in the first year. CONCLUSION: Higher insulin sensitivity at the start of GH therapy is associated with greater first-year growth response to GH, and could be a promising parameter in selecting prepubertal short SGA children for GH treatment. However, this finding needs to be confirmed in larger studies. [less ▲]

The gynaecological issues encountered in children and teenagers lay at the intersection of paediatric endocrinology and gynaecology. More than ten years ago, an outpatient clinic in paediatric ... [more ▼]

The gynaecological issues encountered in children and teenagers lay at the intersection of paediatric endocrinology and gynaecology. More than ten years ago, an outpatient clinic in paediatric endocrinology and gynaecology has been created. Here, we review the last 6 years. 214 girls were included, considering only the first visit for each patient. Collected data are initial concern for this consultation, age at first consultation and confirmed or suspected diagnosis. A classification is done according to the initial concern of patients in six categories. Principal queries concern pubertal development, precocious pilosity or abnormalities in menstrual cycles. Vulvovaginitis and morphologic abnormalities are also frequently encountered. This consultation suggests a paediatric approach with a child feeling confident and a gynaecological examination with a specialist knowing the anatomy particularities and the development of the children. This article focuses on the importance of specific gynaecological examination in children and reviews the main diseases encountered. [less ▲]

Since heterozygous familial hypercholesterolemia (HeFH) is a disease that exposes the individual from birth onwards to severe hypercholesterolemia with the development of early cardiovascular disease, a ... [more ▼]

Since heterozygous familial hypercholesterolemia (HeFH) is a disease that exposes the individual from birth onwards to severe hypercholesterolemia with the development of early cardiovascular disease, a clear consensus on the management of this disease in young patients is necessary. In Belgium, a panel of paediatricians, specialists in (adult) lipid management, general practitioners and representatives of the FH patient organization agreed on the following common recommendations. Conclusion: The aim of this consensus statement is to achieve more consistent management in the identification and treatment of children with HeFH in Belgium. [less ▲]

The involvement of environmental factors such as endocrine disrupting chemicals (EDCs) in the timing of onset of puberty is suggested by recent changes in age at onset of puberty and pattern of ... [more ▼]

The involvement of environmental factors such as endocrine disrupting chemicals (EDCs) in the timing of onset of puberty is suggested by recent changes in age at onset of puberty and pattern of distribution that are variable among countries, as well as new forms of sexual precocity after migration. However, the evidence of association between early or late pubertal timing and exposure to EDCs is weak in humans, possibly due to heterogeneity of effects likely involving mixtures and incapacity to assess fetal or neonatal exposure retrospectively. The neuroendocrine system which is crucial for physiological onset of puberty is targeted by EDCs. These compounds also act directly in the gonads and peripheral sex-steroid sensitive tissues. Feedbacks add to the complexity of regulation so that changes in pubertal timing caused by EDCs can involve both central and peripheral mechanisms. In experimental conditions, several neuroendocrine endpoints are affected by EDCs though only few studies including from our laboratory aimed at EDC involvement in the pathophysiology of early sexual maturation. Recent observations support the concept that EDC cause disturbed energy balance and account for the obesity epidemic. Several aspects are linking this system and the reproductive axis: coexisting neuroendocrine and peripheral effects, dependency on fetal/neonatal programming and the many factors cross-linking the two systems, for instance leptin, adiponectin, Agouti Related Peptide (AgRP). This opens perspectives for future research and, hopefully, measures preventing the disturbances of homeostasis caused by EDCs. [less ▲]

BACKGROUND Etiological diagnosis of hypoglycaemia in infancy is a complex process, requiring careful integration of detailed history, clinical and laboratory data. The causes of recurrent infant hypoglycaemia include excessive insulin secretion, surreptitious insulin administration, deficiency of counter-regulatory hormones and inborn errors of metabolism. CLINICAL CASE A 10 month old girl was admitted at our emergency unit for generalized seizures without fever. Routine laboratory investigations were normal but blood glucose level was at 31 mg/dl. No ketone bodies were found in the urine. Past medical history revealed failure to thrive. A first seizure episode at 8 months of age during family’s holiday is reported. Tests performed in a foreign hospital revealed glycaemia at 36mg/dl. During her stay in our paediatric unit, several hypoglycaemias (31-45 mg/dl) were documented related to irritability as initial symptom of neuroglucopaenia. Detailed medical history revealed that fast tolerance was shorten with hypoglycaemia documented between one to three hours after eating. Clinical examination showed absence of hepatomegaly and failure to thrive: weight, -3SD; height, -2SD, and cranial circumference -2SD. At the time of hypoglycaemia, urinary tests revealed absence of ketonuria, that basically evokes hyperinsulinism or fatty acid oxidation deficiencies but these deficiencies were rapidly excluded by the very short fast state. Blood acylcarnitine profile was normal. Hyperinsulinism is defined by a ratio glycaemia/insulin below 4 with insulin values not necessary high. Since hyperinsulinism can not be excluded with only one blood measure, series of taking were performed during 24 hours. One of these tests was clearly positive with ratio equal to 2.3 (glycaemia at 41 mg/dl, insulin at 18µU/ml). For this patient, ammonemia was also tested with values ranged from 242 to 275 µg/dl (normal < 125) and the diagnosis of hyperinsulinism/hyperammoniemia (hi/ha) was made and confirmed by molecular analysis (mutation c.965G>A (p.R269H) in the GLUD1 gene). The treatment consists in this case by diazoxide and reduction of leucine intakes (< 200 mg of leucine/meal). DISCUSSION Differential diagnosis of hypoglycaemia with absence of ketonuria and absence of hepatomegaly include fatty acids β-oxidation defects, ketogenesis defects and hyperinsulinisms. Short fasting and post-prandial induced hypoglycaemia pointed to hyperinsulinism in our patient. Congenital hyperinsulinism includes KATP, glucokinase or glutamate deshydrogenase mutations. Hi/ha syndrome is due to activating mutations in the GLUD1 gene, coding for the glutamate dehydrogenase (GDH). Such mutations reduce the sensitivity of the enzyme to allosteric inhibition by GTP and consequently increase its sensitivity to allosteric activation by L-leucine. Hyperactivity of the GDH is responsible for over-oxidation of glutamate in β-pancreatic cells, increase of the ATP/ADP ratio and insulin release. Hyperactivity of GDH in liver is also responsible for hyperammonemia, which is usually mild and considered harmless for the brain. Nevertheless, recent studies have shown an increased epilepsy risk in cohorts of patients with hi/ha. CONCLUSION This case points out the importance of necessity for first investigations of infant documented case of hypoglycaemia. Patient history must focus on symptoms such as shorten fast tolerance periods and neurological symptoms of glucose deprivation. Blood samples should be taken at the time of hypoglycaemia and urine samples as soon as possible after the episode of hypoglycaemia. Initial normal insulin values do not allow the exclusion of the diagnosis of hyperinsulinism. [less ▲]

OBJECTIVES: The treatment of brain tumors in childhood is frequently complicated by growth retardation with a high proportion of irradiation (Irr)-induced GH deficiency (GHD) resulting in reduced adult ... [more ▼]

OBJECTIVES: The treatment of brain tumors in childhood is frequently complicated by growth retardation with a high proportion of irradiation (Irr)-induced GH deficiency (GHD) resulting in reduced adult final height (AFH) even after GH therapy (GHT). In order to optimize future GHT protocols, more information on the factors influencing the growth response to GH in these children is needed. This retrospective study evaluated AFH and influencing auxological and treatment factors of a standardized daily biosynthetic GHT in childhood survivors of brain tumors with documented GHD after brain Irr. DESIGN AND METHODS: From the Belgian GH Registry, 57 children survivors of a brain tumor outside the hypothalamo-pituitary area with available AFH were stratified into two groups depending on cranial (C-Irr; n=25) or craniospinal (CS-Irr; n=32) Irr. RESULTS: In the C-Irr patients, results showed an AFH of -0.8 (-2.5, 1.4) SDS (median (range)) and in the CS-Irr patients, results showed a significantly (P<0.001) lower AFH of -1.8 (-4.2, 0.0) SDS. AFH SDS corrected for mid-parental height (MPH) in the C-Irr group was -0.5 (-2.2, 0.9) and -1.5 (-3.6, 0.0) SDS in the CS-Irr group. AFH was positively correlated with age at end of tumor therapy, height SDS at start GHT, height gain SDS first year GHT, and negatively correlated with CS-Irr. CONCLUSIONS: GHT failed to restore adult height to MPH in nearly half of Irr-induced GHD patients for brain tumor, especially those receiving CS-Irr, irradiated at a younger age or shorter at start GHT. [less ▲]

Congenital Isolated hypogonadotropic hypogonadism (CIHH) is caused by an inherited mechanism of impairment of the pituitary-gonadal axis, interfering with gonads' control. Currently, different forms of ... [more ▼]

Congenital Isolated hypogonadotropic hypogonadism (CIHH) is caused by an inherited mechanism of impairment of the pituitary-gonadal axis, interfering with gonads' control. Currently, different forms of HHCI with (Kallmann syndrome or KS) or without anosmia-hyposmia are known. There are six forms of KS already described but in several cases no genetic mutation is found. The genetic anomalies already described are: KAL1 (locus Xp23) coding for anosmine-1, KAL-2 or FGFRI (8p11. locus 2 - p11.1) coding for Fibroblast Growth Factor Receptor 1 (FGFR1), KAL4 or PROk2 (locus 3p21.1) and KAL3 or ProKR2 (locus 20p13) coding respectively for the Prokinecitin-2 and its receptor, KAL5 or CHD7 (locus_8q12.1) coding for a chromodomain helicase DNA-binding protein-7 gene (CHD7) and lastly KAL6 or FGF8 (10Q 24 loci) coding for Fibroblast Growth Factor 8. The other genetic anomalies without anosmia are less frequent. These are associated either with Gnrhl gene (8p2-11. 2), GnRHR (4q21.2), GPR54 (19p13),TAC3R or neurokinine receptor 3 (4 q 25), LH (19q13.32) or FSH (11p13). The isolated congenital hypogonadotrophic hypogonadism phenotype is variable depending on gender, the importance of the deficit, and ultimately, according to a specific regulatory mechanism of the axis, affected by an inherited genetic anomaly. In this review, we describe the essential aspects of the different phenotypes and genotypes of HHCI, in order to assess clinicians an early disease's diagnosis and management. [less ▲]

It has been earlier proposed that oxytocin could play a facilitatory role in the preovulatory LH surge in both rats and humans. We here provide evidence that oxytocin also facilitates sexual maturation in ... [more ▼]

It has been earlier proposed that oxytocin could play a facilitatory role in the preovulatory LH surge in both rats and humans. We here provide evidence that oxytocin also facilitates sexual maturation in female rats. The administration of an oxytocin antagonist for 6 d to immature female rats decreased GnRH pulse frequency ex vivo and delayed the age at vaginal opening and first estrus. The in vitro reduction in GnRH pulse frequency required chronic blockade of oxytocin receptors, because it was not acutely observed after a single injection of the antagonist. Hypothalamic explants exposed to the antagonist in vitro showed a reduced GnRH pulse frequency and failed to respond to oxytocin with GnRH release. Prostaglandin E(2) (PGE(2)) mimicked the stimulatory effect of oxytocin on GnRH pulse frequency, and inhibition of PG synthesis blocked the effect of oxytocin, suggesting that oxytocin accelerates pulsatile GnRH release via PGE(2). The source of PGE(2) appears to be astrocytes, because oxytocin stimulates PGE(2) release from cultured hypothalamic astrocytes. Moreover, astrocytes express oxytocin receptors, whereas GnRH neurons do not. These results suggest that oxytocin facilitates female sexual development and that this effect is mediated by a mechanism involving glial production of PGE(2). [less ▲]